Chapter 224: Improving
the quality of health
care andreducing costs
Public Health Council
November 21, 2012
Great progress on providing health careaccess….
Massachusettshas achieved unparalleled levels of insurance coverage for any US State – over 98%of people are insured
Massachusettsranks #1inAccess on the
Commonwealth Fund State Scorecard 2009
After health reform,over 90% of residentsreport having a usual source of care
Now it’s time to make health careaffordable
Without significant cost containment, total health care spending is projected toincreasefrom $68B in 2010to
$123B in 2020; annualper capita spendingwill growfrom
$10,262 to $17,872
If health insurance premiums growatthe current projected annualrateof6%,Massachusetts workers will lose around$17,000 per workerin overall take‐homepay from 2011‐2019
In 2012, health care costs nowaccount forabout 41% of the state budget, upfrom22% in 1998.
Keyprovisions of the cost containmentlaw
Setsa health care cost growth target
Promotes payment and delivery systemreform
Promotes prevention and wellness
Implements sensiblemalpractice reforms
Addresses marketpower
Continues review of health insurance rates
Supports expansionof healthinformation technology
Implements health resource planning
Provides consumersand employers with quality and cost data to inform decision‐making
Restructuresgovernmentagencies and functions
Health care cost growthtarget
•Setsa first in the nation targetfor controlling the growth of health care costs:
–Annual increase in total health care spendingnot to exceedeconomic growth(Potential Gross State Product,or PGSP) through 2017,PGSP minus 0.5% for next 5 years,then backtoPGSP
–Growth rate ofPGSP in 2013 equals3.6%
•If targetis notmet, the Health Policy Commission can require health careentities to develop and submit PerformanceImprovement plans
Payment and delivery system reform
Alternative payments have the potential toprovide incentives for efficiency in the deliveryofservices that are absent inthe fee‐for‐service system, while potentially promotingimprovementsinquality through better coordination of care
New commissiontoestablishstandards for certificationof accountable care organizations (ACOs) and Patient Centered MedicalHomes (PCMHs)
Commissionwill designate “Model ACOs” that will receive priority in state contracting
Government programs, such as MassHealth, theGIC, and theHealth Connector, are required tomove to alternative payment methods
Engage consumers
•The law gives consumers better information about the price of procedures and health care services by requiring health insurers to provide a toll‐free number and website that enables consumers to request and obtain price information.
•The law allows the creation of “smart tiering” plans that encourage consumers to choose lower‐cost, high qualityproviders
•The law increases the discountfor insurance plans that use limited networks, tiering, or smart tiering
SUMMARY –
DPH RESPONSIBILITIES
Prevention and wellness
Establishes tax credits for businesses worth
25%ofthe costofimplementing awellness
program,up to$10,000 per business.
Requires DPHregulations prior to January 1,
2013.
The DPH, in consultationwiththe Division of Insurance, will produce awellness guide for payers, employers,andconsumers.
Prevention and Wellness Trust Fund
Creates a prevention and wellness trustfund
andprovides $15 million per year over4 years.
The fundsare to be usedto support the state’s
costcontainment goals, andwill be awarded ina
competitive award process.
Form Advisory Council to guide decisionsandevaluateoutcomes
Health resource planning
Oversupplyof health care services is a driver of the overuse of health care services whilethere is a shortage of key clinical services
The law establishes a statewide health planningcounciland advisory committee, creates a statewide publichearing process, and requires the development of a state health resource plan.
The plan willmake recommendations for the appropriate supply and distribution of resources,programs, capacities,technologies and services on a state‐wide or regional basis based on an assessment of need for the next 5 years
Department of Public Healthto issue guidelines, rules or regulations consistent with thestate health plan for making determinations of need
Creation of HealthCare Workforce Center
Develop workforce loan repayment
Encourage primary care workforce development and loan forgiveness at CHCs
Linkage to healthplan timing
Review within4 months
DoNfor all ambulatory andhospital‐based surgical centers
Expanded roles for PAs and NPs
Remove cap on numberof PAsthata MD can supervise
Allow PA’s towrite prescriptionswithout a MD
name, and tosign and stamp on behalf of MD
Responsibility of professional boards
Limited Service Clinics
Nurse practitioners to increaseresponsibilities by providingall services atlimited service clinics
OtherIssues
Moving a patient to another nursing home room
Receipt of reports of nurse overtime
Facilities/providers must reporton palliative care/end of life counseling for patients
Newborn screening – change language‐ “provider”not
“physician”
Development ofchecklists